Because medicine is a profession and physicians are professionals, it is important to have a clear understanding of what "professionalism" means. As a physician-in-training, you will be developing a personal sense of what it means to be a professional. This topic page outlines some common features. Please see the topic page on the Physician-Patient Relationship for further discussion of the professional responsibilities of physicians.
What does it mean to be a member of a profession?
The words "profession" and "professional" come from the Latin word "professio," which means a public declaration with the force of a promise. Professions are groups which declare in a public way that their members promise to act in certain ways and that the group and the society may discipline those who fail to do so. The profession presents itself to society as a social benefit and society accepts the profession, expecting it to serve some important social goal. The profession usually issues a code of ethics stating the standards by which its members can be judged. The traditional professions are medicine, law, education and clergy.
The marks of a profession are:
- Competence in a specialized body of knowledge and skill;
- An acknowledgment of specific duties and responsibilities toward the individuals it serves and toward society;
- The right to train, admit, discipline and dismiss its members for failure to sustain competence or observe the duties and responsibilities.
What is the difference between a profession and a business?
The line between a business and a profession is not entirely clear, since professionals may engage in business and make a living by it. However, one crucial difference distinguishes them: professionals have a fiduciary duty toward those they serve. This means that professionals have a particularly stringent duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Professions have codes of ethics which specify the obligations arising from this fiduciary duty. Ethical problems often occur when there appears to be a conflict between these obligations or between fiduciary duties and personal goals.
What are the recognized obligations and values of a professional physician?
Professionalism requires that the practitioner strive for excellence in the following areas, which should be modeled by mentors and teachers and become part of the attitudes, behaviors, and skills integral to patient care:
- Altruism: A physician is obligated to attend to the best interest of patients, rather than self-interest.
- Accountability: Physicians are accountable to their patients, to society on issues of public health, and to their profession.
- Excellence: Physicians are obligated to make a commitment to life-long learning.
- Duty: A physician should be available and responsive when "on call," accepting a commitment to service within the profession and the community.
- Honor and integrity: Physicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession.
- Respect for others: A physician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.
These values should provide guidance for promoting professional behavior and for making difficult ethical decisions.
A Physician Charter: Medical Professionalism in the New Millennium was issued jointly by the American Board of Internal Medicine, the American College of Physicians and the European Federation of Internal Medicine in 2002. Subsequently, 90 professional associations, including most of the specialty and subspecialty groups in American medicine have endorsed the Charter. The fundamental principles of professionalism are stated as (1) the primacy of patient welfare; (2) patient autonomy; (3) social justice. Professional responsibilities that follow from these principles are commitment to competence, to honesty with patients, to confidentiality, to appropriate relationship with patients, to improving quality of care, to improving access to care, to a just distribution of finite resource, to scientific knowledge, to maintaining trust by managing conflicts of interests and to professional responsibilities.
Is professionalism compatible with the restrictions sometimes placed on physician's judgments in managed care?
One of the principal attributes of professionalism is independent judgment about technical matters relevant to the expertise of the profession. The purpose of this independent judgment is to assure that general technical knowledge is appropriately applied to particular cases. Today, many physicians work in managed care situations that require them to abide by policies and rules regarding forms of treatment, time spent with patients, use of pharmaceuticals, etc. In principle, such restrictions should be designed to enhance and improve professional judgment, not limit it. For example, requiring consultation is ethically obligatory in doubtful clinical situations; penalizing consultation for financial reasons would be ethically wrong. Also, requiring physicians to adhere to practice guidelines and to consult outcome studies may improve professional judgment; requiring blind adherence to those guidelines may be a barrier to the exercise of professional judgment. The presence of rules, policies and guidelines in managed care settings requires the physicians who work in these settings to make such judgments and to express their reasoned criticism of any that force the physician to violate the principles of professionalism.
1. Harden RM. Evolution or revolution and the future of medical education: replacing the oak tree. Med Teach. 2000;22:435–442. doi: 10.1080/01421590050110669.[PubMed][Cross Ref]
2. Harden JR, Crosby MH, Davis M, Friedman RM. AMEE guide no. 14: outcome-based education: part 5-from competency to meta-competency: a model for the specification of learning outcomes. Med Teach. 1999;21:546–552. doi: 10.1080/01421599978951.[PubMed][Cross Ref]
3. Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ. 2014;48:980–987. doi: 10.1111/medu.12520.[PubMed][Cross Ref]
4. Coulehan J. Viewpoint: today's professionalism: engaging the mind but not the heart. Acad Med. 2005;80:892–898. doi: 10.1097/00001888-200510000-00004.[PubMed][Cross Ref]
5. Medical Professionalism Project Medical professionalism in the new millennium: a physicians' charter. Lancet. 2002;359:520–522. doi: 10.1016/S0140-6736(02)07684-5.[PubMed][Cross Ref]
6. Kwon I. Medical ethics as professional ethics. Korean J Gastroenterol. 2012;60:135–139. doi: 10.4166/kjg.2012.60.3.135.[PubMed][Cross Ref]
7. Lee J. State control of medicine through legislation and revision of the medical law: licensed and unlicensed medical practices in the 1950s - 60s. Uisahak. 2010;19:385–431.[PubMed]
8. Hafferty FW, Castellani B. The increasing complexities of professionalism. Acad Med. 2010;85:288–301. doi: 10.1097/ACM.0b013e3181c85b43.[PubMed][Cross Ref]
9. Monrouxe LV, Rees CE, Hu W. Differences in medical students' explicit discourses of professionalism: acting, representing, becoming. Med Educ. 2011;45:585–602. doi: 10.1111/j.1365-2923.2010.03878.x.[PubMed][Cross Ref]
10. Jin P. The physician charter on medical professionalism from the Chinese perspective: a comparative analysis. J Med Ethics. 2015;41:511–514. doi: 10.1136/medethics-2014-102318.[PubMed][Cross Ref]
11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. doi: 10.2307/2529310.[PubMed][Cross Ref]
12. Kniess J. Obesity, paternalism and fairness. J Med Ethics. 2015;41:889–892. doi: 10.1136/medethics-2014-102537.[PubMed][Cross Ref]
13. Kim DH, Kim EJ, Hwang J, Shin JS, Lee S. What is the current orientation of undergraduate medical education in Korea? Korean J Med Educ. 2015;27:87–98. doi: 10.3946/kjme.2015.27.2.87.[PubMed][Cross Ref]
14. Al-Eraky MM, Chandratilake M. How medical professionalism is conceptualised in Arabian context: a validation study. Med Teach. 2012;34:S90–S95. doi: 10.3109/0142159X.2012.656754.[PubMed][Cross Ref]
15. Nishigori H, Harrison R, Busari J, Dornan T. Bushido and medical professionalism in Japan. Acad Med. 2014;89:560–563. doi: 10.1097/ACM.0000000000000176.[PMC free article][PubMed][Cross Ref]
16. Ho MJ, Yu KH, Hirsh D, Huang TS, Yang PC. Does one size fit all? Building a framework for medical professionalism. Acad Med. 2011;86:1407–1414. doi: 10.1097/ACM.0b013e31823059d1.[PubMed][Cross Ref]
17. Pan H, Norris JL, Liang YS, Li JN, Ho MJ. Building a professionalism framework for healthcare providers in China: a nominal group technique study. Med Teach. 2013;35:e1531–e1536. doi: 10.3109/0142159X.2013.802299.[PubMed][Cross Ref]
18. The Korean Association of Medical Colleges. Guidelines for medical education; Available from: http://www.kamc.kr/main/index.php?m_cd=30. Accessed 2 May 2017.
19. An JH, Kwon I, Lee SN, Han JJ, Jeong JE. Study on the medical humanities and social sciences curriculum in Korean medical school: current teaching status and learning subjects. Korean J Med Educ. 2008;20:133–144. doi: 10.3946/kjme.2008.20.2.133.[Cross Ref]
20. Fullan M. The new meaning of educational change. New York: Teachers College Press; 2007.
21. Ellman MS, Fortin AH., 6th Benefits of teaching medical students how to communicate with patients having serious illness: comparison of two approaches to experiential, skill-based, and self-reflective learning. Yale J Biol Med. 2012;85:261–270.[PMC free article][PubMed]
22. The Korea Institute for Healthcare Accreditation (KOIHA). Foundation purpose and History; Available from: http://www.koiha.kr/member/en/contents/ensub01/ensub01_04.do. Accessed 2 May 2017.